A Neural Signature of Anorexia Nervosa in the Ventral Striatal Reward System

University of Ulm, Department of Psychiatry, Leimgrubenweg 12-14, 89075 Ulm, Germany.
American Journal of Psychiatry (Impact Factor: 12.3). 10/2009; 167(2):206-12. DOI: 10.1176/appi.ajp.2009.09010071
Source: PubMed


Animal studies assessing mechanisms of self-starvation under conditions of stress and diet suggest a pivotal role for the mesolimbic reward system in the maintenance of core symptoms in anorexia nervosa, which is corroborated by initial empirical evidence in human studies. The authors examined activity in the ventral striatal system in response to disease-specific stimuli in women with acute anorexia nervosa.
Participants were 14 women with acute anorexia nervosa and 14 matched healthy comparison women who underwent functional magnetic resonance imaging (fMRI) during evaluation of visual stimuli depicting a female body with underweight, normal weight, and overweight canonical whole-body features according to standardized body mass indices. Participants were required to process each stimulus in a self-referring way. Ratings for each weight category were used as the control task.
Behaviorally, women with anorexia nervosa provided significantly higher positive ratings in response to underweight stimuli than in response to normal-weight stimuli, while healthy comparison women showed greater preference for normal-weight stimuli relative to underweight stimuli. Functionally, ventral striatal activity demonstrated a highly significant group-by-stimulus interaction for underweight and normal-weight stimuli. In women with anorexia nervosa, activation was higher during processing of underweight stimuli compared with normal-weight stimuli. The reverse pattern was observed in healthy comparison women.
These findings are consistent with predictions in animal studies of the pivotal role of the human reward system in anorexia nervosa and thus support theories of starvation dependence in maintenance of the disorder.

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    • "For instance, evidence has been found that in the severe and enduring stage of AN brain size is reduced particularly in the cerebellum and mesencephalon [46]. The atypical brain activation to illness relevant cues (for example salient body shape images) is more pronounced in adults than adolescents [43] [44]. "
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    Physiology & Behavior 06/2015; DOI:10.1016/j.physbeh.2015.06.007 · 2.98 Impact Factor
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    • "In particular it is suggested that initially rewarding behaviour becomes habitual when repeated over time, and eventually becomes insensitive to outcome (Graybiel, 2008). The development of compulsive behaviours may be the result of the aberrant reward processing for disorderrelated stimuli, which has been documented in AN (Cowdrey, Finlayson, & Park, 2013; Cowdrey, Park, Harmer, & McCabe, 2011; Fladung et al., 2010; Park, Godier, & Cowdrey, 2014), and substance dependence (Goldstein & Volkow, 2002). Disorder-related reward may become highly motivationally salient and promote the development of compulsive disorder-related behaviour (Godier & Park, 2014). "
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    • "Indeed, chronic food restriction in rats has been found to enhance the rewarding properties of drugs by up-regulating synaptic plasticity in the NAc (Carr, 2007). This increased sensitivity to reward during food restriction may underpin reports of increased salience and attention for disorder-related cues in AN (Fladung et al., 2010, 2013; Giel et al., 2013). Zink and Weinberger (2010) suggest that these disorder-related cues gain incentive salience through a molecular cascade in which starvation induced reductions in glucose and insulin lead to an increase in phasic DA transmission in the VS, a process which conditions associated cues to become highly motivationally salient. "
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